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Title: Towards a more efficacious treatment for oropharyngeal candidiasis (OPC) : hydrogel-forming tablets for the controlled release delivery of chlorhexidine diacetate
Author: Al-Ani, Enas Atallah
ISNI:       0000 0004 7658 4014
Awarding Body: University of Wolverhampton
Current Institution: University of Wolverhampton
Date of Award: 2018
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Oropharyngeal candidiasis is a localised infection in the oropharynx region caused by Candida species, predominately C. albicans. It is commonly spread among immunocompromised patients and aggravated by hyposalivation or xerostomia. Current treatment is by systemic antifungals, which might be accompanied by gastrointestinal tract disorders, headache, allergic reactions and drug interactions or Candida becoming resistant to them. In the present work, the anti-candida activity of chlorhexidine diacetate (CHD) was tested as the drug of choice, it has no systemic side effects and microorganisms do not develop resistance against it. Thymol and farnesol were also tested individually and in combination with CHD to investigate a synergistic effect against Candida planktonic cells. The effects of CHD and thymol were investigated against C. albicans biofilm after two hours exposure by testing the metabolic stress, vacuolar activity and protein content. The results of the anti-Candida activity of CHD and thymol based on the minimum inhibitory concentration (MIC) and the minimum biocidal concentration (MBC) were 2.5 and 5 μg/ml for the former and 125 and 250 μg/ml for the later. Farnesol did not show an MIC and MBC at the investigated concentrations, however, it increased the MIC and MBC of CHD to 5 and 40 μg/ml and of thymol to 250 and >250 μg/ml, respectively. The antibiofilm activity of CHD and thymol was concentration dependent and CHD was more potent than thymol. A concentration of 20 μg/ml and 2 hours treatment of Candida biofilm grown for 24 hours showed an 85% decrease in oxidative stress, 78% and 60% loss of vacuolar activity and protein content, respectively. The combination of both drugs showed a limited increase in the activity. The cytotoxic effects of CHD and thymol were tested on human embryo kidney epithelial cell line (HEK 293); the metabolic stress, lysosomal activity and protein content were tested. The cytotoxic effects were also concentration dependent and the combination have increased the cytotoxicity. A concentration of 20 μg/ml and 2 hours treatment showed a 40% decrease in oxidative stress and neither the lysosomal activity nor protein content of HEK 293 cells was affected by the treatment Finally, a mucoadhesive hydrogel buccal tablets for the controlled release of CHD were designed and prepared to increase the residence time of an effective concentration of CHD in the oral cavity for two hours. They were prepared using Poloxamer 407 (P407), hydroxypropyl methylcellulose (HPMC) and either sorbitol, mannitol or xylitol at different ratios. The tablets were investigated for their physical properties, ex vivo mucoadhesion, the rate of hydration, gelling efficiency using image analysis, differential scanning calorimetry (DSC), Fourier transforms infrared spectroscopy (FTIR), X-ray diffractometry (XRD) and in vitro dissolution using Apparatus I and a novel method based on controlled flow rate to mimic salivary drug delivery in the oral cavity. Based on the antibiofilm activity and the cytotoxic effect of CHD a concentration of 20 μg/mL was chosen to be released from the tablets to maintain both efficacy and safety. Accordingly, to maintain this concentration the final formulations were prepared with a 2.5 mg dose of CHD. Tablets analysis showed no chemical interaction with the excipient based on DSC, FTIR and XRD. Furthermore, a novel dissolution method was developed based on a constant flow rate of the dissolution media to mimic oral salivary flow. By comparing CHD release using App I and the flow rate method it was shown that hydrogel-forming tablets successfully controlled the release of CHD regardless of the volume of the dissolution media with approximately 90% release and an average release concentration of 19 μg/ml and 1 ml/min flow rate. This making it a potential candidate for future application for treatment of candidiasis in all types of patients.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Oropharyngeal candidiasis ; Chlorhexidine diacetate ; Mucoadhesion ; Hydrogel ; Xerostomia ; Controlled release ; Buccal tablet